TUNNEL POSITIONING IN REMNANT SPARING DOUBLE BUNDLE ACL RECONSTRUCTION — A 2-YEAR STUDY OF MRI TUNNEL POSITIONS, CLINICAL OUTCOMES AND TUNNEL CONFLUENCE

Abstract

Purpose: The purpose of this study is to examine the outcomes of a cohort of patients who have undergone a new surgical technique for anterior cruciate ligament (ACL) tunnel targeting using the footprint of the torn ACL as soft tissue markers. This is in the setting of anatomical ACLR with remnant preservation. Methods: This retrospective single center cohort study was conducted on patients undergoing a primary ACLR between August 2008 and February 2013. A total of 103 patients underwent ACLR with a remnant sparing technique with non-radiological soft tissue targeting of femoral and tibial tunnels. Exclusion criteria included skeletal immaturity, concomitant meniscal repair or ligament surgery, knee malalignment, delayed presentation ([Formula: see text]6 months post injury) and incomplete medical insurance. At 2 years all patients had gadolinium MRI scan, plain film X-ray, and a clinical assessment including KT-1000 arthrometry, and the following outcome scores; Tegner, IKDC (subjective/objective), Lysholm, Cincinnati and ACL Quality of Life. Results: A total of 44 patients (18 males, 26 females; mean age 30.9 years [Formula: see text]/[Formula: see text]11.8) were enrolled within the study. About 93.2% of the participants achieved an IKDC objective rating of A or B. The mean scores for outcome measures were; IKDC Subjective (84.9[Formula: see text][Formula: see text]/[Formula: see text][Formula: see text]11), Tegner (6.1[Formula: see text][Formula: see text]/[Formula: see text][Formula: see text]2), Lysholm (87.2[Formula: see text][Formula: see text]/[Formula: see text][Formula: see text]11.3), Cincinnati (358.1[Formula: see text][Formula: see text]/[Formula: see text][Formula: see text]40.8) and ACL Quality of Life (75.4[Formula: see text][Formula: see text]/[Formula: see text][Formula: see text]19). There were no graft failures at follow up. No patients had a loss of full extension [Formula: see text]. All tunnels were positioned satisfactorily. Almost half of all femoral tunnels (47.8%) and 30.4% of tibial tunnels were confluent at the joint surface. Conclusions: This series demonstrates that anatomical double tunnel ACLR using non-radiological guided remnant retention technique, provides satisfactory 2-year clinical outcomes and is a safe and effective option. Targeting tunnels to be within the native remnant leads to high rates of tunnel confluence.